Dual diagnosis therapy

A group of clinical researchers in New Hampshire, USA, who are highly experienced in the treatment of substance abuse in the severely mentally ill have identified certain key principles of management (Drake et al. 1993, 2001), which are shown in Table 7.4. They consider that a special approach is necessary because the severely mentally ill do not identify problems in the same way, they typically have difficulty with addiction treatment approaches such as group therapy, and there is an ever-present danger that this group fall between two sets of services. Their work is in a unit specifically for dual diagnosis patients. 

The same New Hampshire group have described continuous treatment teams (Drake et al. 1996), who treat the dual diagnosis patients, with 24-hour responsibility for case management. There is a flexible approach to individual and group therapy, the latter being either educational or treatment-oriented in the case of those committed to abstinence. There is a practical focus on social situation, social skills and aspects of daily living. 

Incorrect diagnosis is the most common cause for nonresponse to antidepressants. Two common examples are dual depression, in which a superimposed MDD improves with antidepressant therapy but dysthymic symptoms persist and are mistaken for unimprovement, and affective disturbances associated with alcohol or drug abuse, which may persist even though symptoms of the MDD improve with drug therapy. 

The phase III duals for currently approved MS immunotherapies follow ed the use of the therapy for 20 months or less. Long term efficacy and compliance can be an important factor since historic data show that people wdth MS lived on average 35 years followdng diagnosis even before cuiTent therapies (Smith and McDonald, 1999). Usually MS only decreases life expectancy by 2-3 years. How ever, prior to the advent of current therapies, 50% of those wdth MS needed assistance (a cane to w alk over one half block) 15 years after diagnosis (Weinshenker et al., 1989). 

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